employment application TELL US WHAT TYPE OF CAREER YOU ARE LOOKING TO BUILD
TELL US ABOUT YOU FULL NAME
TODAY’S DATE
John Doe
8/8/17
ADDRESS
Please rank 1 through 3 those that interest you most. 1 being most preferred 3 being least preferred
901 Iowa CITY STATE ZIP
Lawrence
Kansas
66044
PHONE E-MAIL ADDRESS
oooooo@gmail.com
000-000-0000 _ RETAIL Includes front end, center store and produce positions. Primary functions include hospitality, receiving, restocking, cashiering and light janitorial. _ FOOD SERVICES Includes deli, cafe, bakery, kitchen and meat & seafood positions. Primary functions include team work, counter service, basic food prep, packaging, stocking, light janitorial, maintaining high food safety standards. _ OTHER Is what you would like to do with us not listed? Tell us what you hope to find.
If hired, can you provide evidence of your right to work in the United States?
� ✔
YES
�
NO
WHEN ARE YOU AVAILABLE? When can you start?
ASAP Date: _________________________________
How many hours per week can you work?
� �
THE MERC CO+OP’S HOURS OF OPERATION Monday
4 a.m.-11 p.m.
Tuesday
4 a.m.-11 p.m.
Wednesday
4 a.m.-11 p.m.
Thursday
4 a.m.-11 p.m.
Friday
4 a.m.-11 p.m.
Saturday
4 a.m.-11 p.m.
Sunday
4 a.m.-11 p.m.
✔
Full Time: 30+ hours per week Peak Time: up to 29 hours per week
DUE TO THE NATURE OF OUR RETAIL BUSINESS, APPLICANTS WITH GREATER AVAILABILITY ARE MORE LIKELY TO RECEIVE A JOB OFFER
WHY YOU WANT TO WORK AT THE MERC CO+OP?
APPLICATION ACCEPTANCE Unless otherwise noted, applications are accepted on Thursdays from 2:00-3:00 p.m. during our “Get to Know You” interview sessions. EMPLOYMENT APPLICATION 8/2017
© THE MERC CO+OP
PRIOR WORK EXPERIENCE List in order your last three jobs, beginning with the most recent or present employer. EMPLOYER INFORMATION Employer
City
Title
Date Started
Lawrence Date Ended
Responsibilities
EMPLOYER INFORMATION Employer
City
Lawrence Title
Date Started
Date Ended
Responsibilities
EMPLOYER INFORMATION Employer
City
Lawrence Title
Date Started
Date Ended
Responsibilities
Do you have formal (six months or more) experience with any of the following? Check all that apply.
� Supervision � Training � Open Book Management � Food Safety, i.e. ServSafe or
state issued food handler’s card
� Commercial Food Equipment � Receiving Equipment Operation � Cross-Cultural Competency � Microsoft Office Suite � Cooperatives (co-ops)
AUTHORIZATION I authorize my present and former employers (unless otherwise indicated on this application) to release to The Merc Co+op any information concerning my employment, including my job performance. Further, I release all these parties from liability for any damage (resulting from misrepresentation) which might result from furnishing this information. The information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I understand that falsified information or significant omissions may disqualify me from further consideration and may be considered justification for dismissal if discovered at a later date. In understand that because The Merc Co+op has elected to ‘ban the box,’ all potential employees are eligible for a random background check. I understand that employment with The Merc Co+op is for no definite period of time. The Merc Co+op has the right to terminate the employment relationship at all times.
APPLICANT SIGNATURE DATE
EMPLOYMENT APPLICATION 8/2017
THE MERC CO+OP IS AN EQUAL OPPORTUNITY EMPLOYER
© THE MERC CO+OP